American Indians have been characterized as having high rates of Fetal Alcohol Syndrome (FAS). There is, however, substantial variation in rates among Indian communities/tribes. This research will continue a unique multi-site prevention trial and FAS/ARND diagnostic trial. It extends measurement of effectiveness of a comprehensive, public health model, FAS prevention program designed from Institute of Medicine (IOM) recommendations. It also continues further standardization and operationalization of the IOM diagnostic criteria recommended for diagnosing FAS spectrum disorder (FASD). The prevention program utilizes a combination of control and pre/post measure designs to assess indicated, selected, and universal prevention techniques applied by four Plains Indian communities, two controls, and one urban research site. Utilizing specific techniques of research and prevention developed previously in American Indian communities, the study further assess effectiveness of comprehensive, community-wide prevention of FAS its extent and which specific techniques are most viable. The program will continue to measure and define the epidemiologic characteristics of FAS, adult drinking characteristics, maternal risk factors for FASD and the diagnoses of FAS, Partial FAS, and FASD. The specific aims of this research are: to continue the well established, multi-site/system of comprehensive IOM-based FAS prevention for American Indians; to measure effectiveness over an extended period through: change in age-specific FAS prevalence rates, formative evaluation of specific prevention components, and secondary (proxy) measures; to monitor adult drinking and associated risk factors (KABB) in the target communities over time; to determine the effects of comprehensive FAS prevention across sites; to further delineate and define maternal risk factors for FAS; and to advance the diagnostic rigor for FASD. The preventive interventions are implemented by two FTE personnel at each of the four, and eventually six, prevention sites, and also by university-based researchers. In indicated prevention: research-defined maternal risk factors guide case management strategies to change unhealthy practices of high risk individuals; brief interventions use community reinforcement approach (CRA) and motivational enhancement therapy (MET) principles and birth control and individual skill building. In selected and universal prevention, routine screening for alcohol abuse, targeted messages to specific aggregates, policy advocacy, and community motivation are used. Results are applicable to most American Indian and Alaska Native, national, and international communities. From the initial NIAAA funding of this comprehensive trial, a sophisticated research/prevention network has been established with experts in all areas needed: survey research, diagnosis, and prevention. The proposed renewal will ensure sufficient time to test the IOM model of prevention while advancing science in several other ways.